Key Points
ÎComplicated intra-abdominal infections are common problems, with appendicitis alone affecting approximately 300,000 patients/year, and consuming over 1 million hospital days.
ÎIntra-abdominal infections are the second most common cause of infectious mortality in the intensive care unit.
Fluid Resuscitation
ÎPatients should undergo rapid restoration of intravascular volume and additional measures as needed to promote physiological stability (A-II).
Initiation of Antimicrobial Therapy
ÎAntimicrobial therapy should be initiated once a patient is diagnosed with an intra-abdominal infection, or such an infection is considered likely. For patients in septic shock, antibiotics should be administered as soon as possible (A-III).
ÎUse of agents listed as appropriate for higher severity community-acquired infections and health care-associated infections is not recommended for patients with mild-to-moderate community-acquired infections since such regimens may carry a greater risk of toxicity and facilitate acquisition of more resistant organisms (B-II).
Antimicrobial Therapy—Community-Acquired Infection of Mild-to-Moderate Severity
ÎAntibiotics used for empiric treatment of community acquired intra- abdominal infection should be active against enteric gram-negative aerobic and facultative bacilli and enteric gram-positive streptococci (A-I).
ÎCoverage for obligate anaerobic bacilli should be provided for distal small bowel, appendiceal, and colon-derived infection and for more proximal gastrointestinal perforations in the presence of obstruction or paralytic ileus (A-I).
Antimicrobial Therapy—High Risk Community-Acquired Infection
ÎUse of broader-spectrum agents providing activity against some gram- negative facultative and aerobic organisms that are occasionally isolated from such patients has the potential to improve outcomes, although this hypothesis has not been rigorously examined in clinical trials.
